August 19, 2013
OVERVIEW: TUBERCULOSIS CONTROL
Tuberculosis (TB) is a disease of poverty, mainly affecting young adults in their most productive years. For the first time in many years, recent World Health Organization data suggest that the absolute number of TB cases has been falling since 2006. Despite this achievement, TB continues to be one of the top causes of death among women ages 15-44, and in 2009 almost 10 million children were orphaned as a result of parental deaths caused by TB. The World Bank is committed to helping developing countries control and reduce the spread of TB.
In 2011, about 1.43 million deaths were attributable to TB, including an estimated 430,000 people with HIV. In 2011, multidrug-resistant TB (MDR-TB) rates were reported to be still increasing. According to a 2010 WHO survey, new TB cases peaked at 28% in some areas of the former Soviet Union, while extensively drug-resistant TB (XDR-TB) cases have been reported in 84 countries, up from 58 in 2010. To meet these challenges, the World Bank has adopted a multi-pronged approach to TB control.
The Bank addresses TB directly but also by supporting tobacco control measures, health systems strengthening, and the improvement of public housing and environment. The Bank supports full-scale implementation of the WHO-recommended “Directly Observed Treatment Strategy” (DOTS). From 2005-2012, the Bank’s cumulative commitments to TB control totaled about US$285 million in 17 projects in 16 countries and three multi-country projects in Africa and Central Asia. The Bank also invests in projects to reduce smoking prevalence. Smoking increases the risk of TB by a factor of more than two-and-a-half times. Health systems strengthening activities that support TB control include the modernization of public health laboratory networks, health personnel training for timely detection and diagnosis, and improved technical capacity at various levels of the health system. This is important for monitoring and evaluation, which is a key building block for disease surveillance, program management, and tailoring policy to the specific needs of the country.
Additionally, the Bank supports improvements in public housing—in particular related to indoor air pollution—which reduce the risk of contracting TB.
The Bank is a permanent member of the Stop TB Partnership's Coordinating Board. Bank staff collaborate with other Stop TB partners at the global and country level.
India carries one-fifth of the world’s TB burden. Bank support has helped India more than triple treatment success rates since 1997, from 25% to 86%. TB death rates have decreased seven-fold from 29% to 4%, and about 1.7 million additional lives have been saved. Bank commitments accounted for a significant proportion of central government funding of India’s tuberculosis (TB) control program during the period 2006-12.
The program has expanded coverage of standardized diagnosis and treatment services (DOTS) to the entire population. For diagnosis, it has established more than 13,000 sputum microscopy centers in the laboratories of primary health facilities across the country, while more than 400,000 DOTS providers manage treatment with “patient-wise” boxes of the full course of medication.
The program has ensured uninterrupted drug supply for first-line treatment through centralized procurement and an effective logistics system. The program has met internationally-adopted targets, exceeding 70% detection of new smear-positive TB cases and successfully treated over 85% of those cases. It has had considerable success in collaboration with the national HIV/AIDS program. It has expanded diagnosis and treatment of multi-drug resistant TB (MDR-TB), establishing four national reference laboratories and 31 accredited state-level laboratories for diagnosis, so far putting on treatment a total of 6,871 MDR-TB patients a substantial increase from last year (969 patients).
The Bank is also engaged in policy dialogue regarding the country’s five-year national TB Control program while stepping up work on tobacco taxation.
East Africa is beset with co-infection of TB and HIV. MDR-TB and regular TB in AIDS patients need specialized laboratories for diagnosis and treatment. Launched in May 2010, the Bank-supported East Africa Public Health Laboratory Networking Project provides a network of high-quality public health laboratories to improve access to TB diagnostic services among vulnerable populations living in the cross-border areas of Kenya, Tanzania, Uganda, and Rwanda. In 2012, Burundi was added to the project, funded by an additional US$15 million from IDA.
Project achievements include: (i) training and certifying regional assessors; (ii) conducting peer review assessments of all laboratories in the network in the five East Africa Community (EAC) countries, using regional standards developed by WHO/AFRO; and (iii) presenting a joint regional framework for cross-border surveillance to the EAC health committee before seeking ministerial endorsement. The project also supports implementation of new technology (GeneXpert) for fast and accurate diagnosis of multidrug-resistant TB (MDR-TB).
From 2002 to 2010, the Bank-supported China Tuberculosis Control Project—the largest effort of its kind ever conducted—provided access to effective TB control services in 16 provinces, covering an estimated 668 million Chinese citizens. The project reduced TB-associated deaths by 770,000, and prevented 20 million people from being infected by TB and 2 million people from falling ill.